Quality of life of patients with hip fracture was better during the COVID-19 period than before, an ancillary study from the HiFIT multicenter study

BackgroundThe COVID-19 pandemic had a global impact on people life, notably because of lockdown periods. This could particularly affected patients suffering from hip fracture, who could have been more isolated during these periods. We aim at evaluating the impact of the COVID-19 period (including lockdown periods) on quality of life (QOL) in older adult patients 90 days after a surgery for a hip fracture.Subject and methodsAncillary study of the prospective randomized controlled HiFIT study. We compared the QOL measured at 90 days after a hip fracture surgery using the EuroQOL-5 dimensions 3 levels (EQ-5D), the Perceived Quality of life (PQOL) and the Instrumental Activities of Daily Living (IADL) in patients included in the Hifit study before and during the COVID-19 pandemic.ResultsThe characteristics of the 161 patients included before and of the 213 included during the COVID period (including 122 (57%) during COVID with containment periods and 91 (43%) during COVID without containment periods) were similar (mean age 84 ± 10 years; 282 (75%) women). The majority (81%) of the patients alive at 90 days had returned to their previous place of residence in both periods. During the COVID period, EQ-5D showed better patient pain/discomfort and anxiety/depression levels. The PQOL happiness was not different, with around 81% of the patient being “happy” or “very happy” during the two periods and the IADL was also similar during the two periods. In the multivariate analysis odd ratios of having poorer outcomes were increased before COVID for pain/discomfort (OR 2.38, 95%CI [1.41–4.15], p = 0.001), anxiety (OR 1.89 [1.12–3.21], p = 0.017) and mobility (1.69 [1.02–2.86], p = 0.044).ConclusionPatient’s quality of life measured using different scales was not altered during the COVID period compared to before COVID, 90 days after a hip fracture. Surprisingly, the Pain/Discomfort and Anxiety dimensions of the EQ-5D questionnaires were even better during the COVID period.Clinical trial registration:https://clinicaltrials.gov/ (NCT02972294)

Description et analyse des prescriptions d'antidépresseurs chez les adultes, parmi un échantillon de généralistes de Haute-Normandie

Contexte : Les antidépresseurs sont prescrits à 80% par des MG. La dépression et les troubles anxieux restent les principales indications. Leurs indications se sont étendues, officielles ou non. En 2010, 6% des français ont consommé un antidépresseur. L'objectif de cette étude est la description et l'analyse des prescriptions chez l'adulte en médecine générale. Méthode : Cette étude épidémiologique a été réalisée auprès de médecins généralistes haut-normands. Vingt-huit médecins ont inclus les patients vus sur une semaine. Le premier questionnaire décrivait les caractéristiques démographiques et l'activité des médecins. Le second a été rempli pour tous les patients traités par antidépresseurs sur les 6 derniers mois. Les caractéristiques démographiques du patient, son traitement (en cours ou non, molécule, posologie, durée, primo-prescripteur, observance) ont été recueillies. Résultats : Sur 3554 patients inclus, 8% avaient un traitement en cours, initié par un MG dans 73,4% des cas. Les femmes représentait 72,4% des patients, les patients d'âge moyen (40-64 ans) 57,5% des patients. Les ISRS et IRSN représentaient 70,8% des prescriptions. La paroxétine était la molécule la plus prescrite (18%). 42% des patients ont été traités moins de trois mois. 36,7% des traitements duraient plus de 2 ans. Les traitements initiés par un généraliste étaient significativement plus courts que ceux initiés par les autres spécialistes. Conclusion : La prévalence de prescription des antidépresseurs est élevée. Les durées courtes de traitement posent la question de l'observance par le patient et de la pertinence de l'indication par le médecin. Les molécules les plus utilisées ne sont pas forcément les mieux tolérées ni celles qui présentent le moins d'interactions médicamenteuses. L'amélioration des pratiques en MG passe par une meilleure prise en compte de ces paramètres

Covariance Matrix Adaptation Evolution Strategy for Multidisciplinary Optimization of Expendable Launcher Families

International audienceAfter 30 years of success of Ariane launches, Astrium Space Transportation as prime contractor is preparing the future of launch vehicles with research and development activities. This paper describes the results of the collaboration between INRIA and Astrium to solve the typical multidisciplinary problem of expendable launch vehicle design thanks to the Covariance Matrix Adaptation Evolution Strategy (CMA-ES). The different disciplines integrated in the Multidisciplinary platform are propulsion system, aerodynamics, mass budget, trajectory integration, control. CMA-ES was tested on a two-liquid-staged launcher with solid boosters. The algorithm produced conclusive results on an optimization problem that proved to be very ill-conditioned. The comparison with Non-Dominated Sorting Genetic Algorithm NSGA-II gave equivalent results on a bi-level optimization, the trajectory sub- problem being solved separately by a reduced gradient method. The good performance of CMA-ES on a single launcher case allowed us to extend the tests on a launcher family. A launcher family is composed of several launcher configurations sharing common characteristics with different payload targets and optimized together. In these last cases, CMA-ES surpasses NSGA-II in terms of performance and was able to handle multiple error cases during the search of optimum

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Multidisciplinary Optimization in the Design of Future Space Launchers

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